International Journal of Women's Health最新文献

Background: Human papillomavirus (HPV) infection is a prevalent sexually transmitted infection, significantly contributing to cervical lesions and cancer. It not only damages physical health but also causes substantial mental problems, including depression and anxiety. However, research remains fragmented in China.

Methods: A hospital-based cross-sectional study was conducted in Shenzhen, China, from December 2024 to February 2025. Five hundred and one female participants with HPV infection, cervical lesions, or cancers were recruited via convenience sampling. Data on demographic characteristics, HPV-related information, and psychosocial indicators were collected using a self-reported questionnaire. Key measures included the 9-item Patient Health Questionnaire (PHQ-9, cutoff ≥10 for PHQ-defined depression), 7-item Generalized Anxiety Disorder Scale (GAD-7, cutoff ≥10 for GAD-defined anxiety), 14-item Fatigue Scale (FS-14, higher scores = more severe fatigue), 10-item Connor-Davidson Resilience Scale (CD-RISC-10, higher scores = stronger resilience), and 5-item Mindful Attention Awareness Scale (MAAS-5, higher scores = lower mindfulness levels). Univariate analysis and multivariable binary logistic regression were performed to identify factors associated with depression and anxiety.

Results: The prevalence of PHQ-defined depression and GAD-defined anxiety was 22.36% (n=112/501, 95% CI: 0.187-0.260) and 21.36% (n=107/501, 95% CI: 0.178-0.250), respectively. Multivariable binary logistic regression indicated that high-grade cervical lesions or cervical cancer (vs HPV infection or low-grade cervical lesions; Depression: OR = 8.879, P < 0.00; Anxiety: OR = 14.154, P < 0.001) and poor sleep condition (Depression: OR = 1.155, P = 0.004; Anxiety: OR = 1.175, P < 0.001) emerged as significant predictors of depression and anxiety, whereas higher levels of resilience (Depression: OR = 0.896, P = 0.001; Anxiety: OR = 0.934, P = 0.018) demonstrated a protective effect among females infected with HPV. Meanwhile, the results also found that fatigue (OR = 1.284, P = 0.008) and lower mindfulness level (OR = 1.163, P = 0.011) were also associated with depression among females infected with HPV.

Conclusion: This study reveals a high prevalence of depression and anxiety among HPV-infected women, along with the associations between PHQ-defined depression, GAD-defined anxiety, and advanced disease staging, fatigue, lower mindfulness, and higher resilience in women infected with HPV. Routine mental health assessment is warranted for this population, especially for those with high-grade cervical lesions or cervical cancer.

Purpose: To assess the incidence of complete tooth loss and dental visits in menopausal women and to identify relevant influencing factors in China.

Methods: This study analyzed data of 5,602 women sourced from the China Health and Retirement Longitudinal Study (CHARLS) during 2015. The incidence of complete tooth loss and dental visits in menopausal and non-menopausal women was explored. Univariate and multivariate logistic regression models evaluated the relationships between demographic background, health status and function, health care and insurance, blood data and complete tooth loss and dental visits in menopausal women. The results were expressed as odds ratios (OR) of 95% confidence intervals (CI).

Results: Risk factors for complete tooth loss in menopausal women included age (OR=1.09, 95% CI: 1.08-1.11), living in villages (OR=1.58, 95% CI: 1.29-1.93), smoke (OR=1.29, 95% CI: 1.01-1.65). Factors for dental visits in menopausal women included age (OR=0.99, 95% CI: 0.98-1.00), living in villages (OR=0.75, 95% CI: 0.64-0.88).

Conclusion: This study found that menopausal women have higher rates of complete tooth loss and dental visits. Age, place of residence, and smoking are major risk factors for complete tooth loss, while age and place of residence influence dental visits, indicating that menopausal women should pay more attention to their dental health, improve compliance with dental visits, and actively intervene to prevent tooth loss.

Background: Oxidative stress is a critical mediator in ovarian aging, a key process leading to premature menopause (PM), which is defined as menopause before age 40. While the Oxidative Balance Score (OBS), a composite measure of dietary and lifestyle pro- and anti-oxidant exposures, provides valuable insight, its association with PM remains unclear. This study aimed to investigate the association between OBS and PM in a nationally representative US population.

Methods: This cross-sectional study utilized data from 4,128 participants in the National Health and Nutrition Examination Survey (NHANES) 2007-2018. The OBS was calculated from 16 dietary and 4 lifestyle components. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs), with all analyses accounting for the complex survey design using appropriate NHANES sample weights. The potential nonlinear relationship was explored using restricted cubic splines (RCS).

Results: A higher total OBS was significantly associated with a lower risk of PM (Adjusted OR for the highest compared to the lowest quartile, 0.51; 95% CI, 0.31 to 0.83). The dietary OBS component showed a consistent inverse association. Subgroup analysis suggested potential ethnic variations, although the interaction did not reach statistical significance (P for interaction = 0.054). RCS analysis confirmed a nonlinear inverse association. Further threshold effect analysis identified a turning point at an OBS of 28; the association was significant below this threshold (OR per unit increase, 0.95; 95% CI, 0.93 to 0.97), but this was not observed above it (OR, 1.09; 95% CI, 1.00 to 1.18).

Conclusion: In this nationally representative sample of US women, a higher OBS was associated with a lower risk of PM, particularly below a score of 28. These findings suggest that dietary and lifestyle factors contributing to antioxidant balance may play a role in preserving ovarian function, although prospective studies are required to confirm causality.

Purpose: This study analyzed physical activity (PA) trajectories, identified subgroups, and explored their associations in women with gestational diabetes mellitus (GDM).

Methods: From January to November 2024, a longitudinal study was conducted using convenience sampling to recruit women with GDM from a maternal and child health hospital in Guangzhou (China). General information and baseline PA data were collected at diagnosis (24--26 weeks of gestation), and follow-up PA assessments were carried out at 28, 32, and 36 weeks. The Pregnancy Physical Activity Questionnaire (PPAQ) was used to assess PA levels. The latent class growth model (LCGM) identified distinct PA trajectories.

Results: Of the 236 women enrolled, 223 completed follow-up. PA scores increased from T0 to a peak at T1 (median 156.45 MET·h/w, IQR: 113.08-221.10), then declined to a low at T3 (114.63 ± 47.30 MET·h/w). LCGM identified three trajectory subgroups: high-level reduction (4.04%), moderate-level fluctuation (43.50%), and low-level stable (52.47%). Ordinal logistic regression showed that unemployment (odds ratio (OR): 4.754; 95% confidence interval (CI): 1.878-12.037) and exercising alone (OR: 2.268; 95% CI: 1.219-4.225) were significantly associated with subgroup membership (P<0.05).

Conclusion: PA levels in women with GDM initially rose and then declined, with most sustaining stable low activity. Unemployment and solitary exercise were significant predictors of lower PA trajectories.

Background: Cancer is a significant cause of morbidity and mortality among women worldwide, particularly breast and cervical cancers. Continuity of care (CoC) is essential for effective cancer management but is often hindered by systemic, social, and economic barriers. Patient navigation has emerged as a promising intervention to improve access and coordination across the cancer care trajectory.

Purpose: This review aimed to explore how patient navigation has been applied to support continuity of cancer care for women.

Methods: This scoping review was conducted based on the framework developed by Arksey and O'Malley (2005). Comprehensive literature search across five electronic databases, including CINAHL, PubMed, ScienceDirect, Scopus, Taylor & Francis, and search engine: Google Scholar. Eligible studies included English-language, original articles that involved women aged 18 years or older, focusing on the impact of patient navigation on continuity of care for cancer. Data were extracted independently by three reviewers using a standardized form. A thematic analysis approach was used to synthesize the findings across key domains.

Results: A total 26 studies were included, most of which were conducted in the United States. Patient navigation demonstrated positive impacts across the cancer care continuum: (1) improved screening, especially in minority populations; (2) reduced time to diagnostic resolution; (3) improved patient treatment and rehabilitation. Five thematic domains were identified: care coordination, education/information, empowerment, emotional and social support, and logistical or financial assistance.

Conclusion: This scoping review provides an overview of how patient navigation contributes to strengthening the continuity of cancer care for women and identifies gaps in its current implementation across settings. Future research should investigate scalable and culturally adapted navigation models in low-resource settings, evaluating their cost-effectiveness and long-term outcomes.

Introduction: Effective ovarian stimulation and luteal phase support (LPS) are key factors for the success of in vitro fertilization and embryo transfer (IVF-ET) The present multicenter randomized trial evaluates whether adding Gushen Antai Pill (GSATP) to standard LPS improves the ongoing pregnancy rate (OPR) in women with normal ovarian reserve (NOR) undergoing fresh embryo transfer.

Methods: This study is a multicenter, randomized, double-blind, placebo-controlled trial, taking place at 20 reproductive centers within public tertiary hospitals. We plan to enroll around 800 women who are expected to have a NOR. Participants are randomized 1:1 using a stratified block randomization method with block sizes of 4 and 6, stratified by age (<35 vs ≥35 years). The primary endpoint is the OPR, with comprehensive safety evaluations also being performed. Data analysis will adhere to both intention-to-treat (ITT) and per-protocol (PP) principles to ensure robust statistical validity.

Discussion: This randomized controlled trial (RCT) aims to evaluate the effectiveness and safety of combining LPS with GSATP to improve pregnancy outcomes in women with NOR who are undergoing fresh embryo transfer. By rigorously evaluating endpoints such as OPR and early pregnancy complications, this study seeks to establish evidence for GSATP as a potential adjuvant therapy in IVF-ET protocols. The findings may offer innovative therapeutic perspectives for integrating traditional Chinese medicine (TCM) into contemporary assisted reproductive technology, particularly in enhancing implantation conditions and reducing miscarriage risks during fresh cycles.

Trial registration: ClinicalTrials.gov, ID: NCT04872660, 05/04/2021.

Purpose: This study aimed to investigate the causal relationship between sleep and Premature ovarian insufficiency (POI) using genetic methods and to evaluate the efficacy and safety of the Chinese herbal medicine Ningxin-Tongyu-Zishen Formula (NTZF) combined with hormone replacement therapy (HRT) on reproductive hormone levels and sleep quality in patients with POI through a clinical controlled trial.

Patients and methods: A multi-stage research design was implemented. Initially, a cross-sectional analysis was conducted on 200 POI patients. Two -sample Mendelian randomization analysis (MR) was then performed using publicly available data from the UK Biobank and FinnGen to infer causal relationships. Finally, a clinical observational study involving 119 patients compared three regimens over a 6-month treatment period: NTZF combined with HRT, NTZF alone, and HRT alone. The primary outcomes were reproductive hormone levels and the Pittsburgh Sleep Quality Index (PSQI).

Results: Cross-sectional analysis showed that decreased sleep quality was an independent risk factor for altered reproductive hormone levels in POI patients. MR analysis further provided genetic evidence that insomnia may be a causal risk factor for POI. The clinical study indicated that NTZF combined with HRT was significantly more effective than either monotherapy in improving reproductive hormone levels, enhancing sleep quality, and overall clinical efficacy, with a favorable safety profile.

Conclusion: This study confirmed a strong association between sleep quality and POI from both epidemiological and genetic perspectives. NTZF combined with HRT, as an integrated traditional Chinese and Western medicine therapy, can synergistically improve reproductive endocrine and sleep disturbances in POI patients, providing a new and effective strategy for clinical management.

Background: Early onset preeclampsia (E) causes severe complications that lead to morbidity and mortality in women. Various screening methods have been implemented, including the Ministry of Health's scoring system and eoPEE prevention programs implemented in primary health care in Indonesia.

Purpose: The objectives of this study were: 1) To determine the results of screening for eoPE risk factors using the Ministry of Health's scoring system, 2) To evaluate the accuracy of the Ministry of Health's scoring system in predicting the occurrence of eoPE.

Patients and methods: This prospective cohort design study was conducted from October 2021 to September 2022 in 38 primary health centers in Banyumas Regency, Central Java Province, Indonesia. A purposive sampling technique was utilized. The pregnant women with a gestational age of <20 weeks who were screened for eoPE risk factors using the Ministry of Health's scoring system at the first pregnancy visit were included as research participants. Data were processed using SPSS version 29, and a 95% confidence interval was used to determine the significance level.

Results: The results revealed that 563 (13.9%) were classified as high risk for developing eoPE. The incidence of eoPE among those pregnancy screened was 2.5%. The most common maternal risk factors associated with eoPE were mean arterial pressure (24.8%), age ≥35 years (18.6%), and pre-pregnancy obesity (7.5%). The sensitivity, specificity, positive predictive value, and negative predictive value of the scoring system for eoPE were 52%, 87.1%, 9.6%, and 98.6%, respectively.

Conclusion: It is concluded that the scoring performance test requires modification or other approaches to increase its sensitivity and positive predictive value. Modification of this system requires an approach that is easy, inexpensive, and feasible to be carried out in developing countries.

Purpose: To explore the effects of long-term exposure to air pollutants on risk of death and survival time of breast cancer patients.

Methods: We retrospectively collected data of 4,438 primary breast cancer patients treated at the Affiliated Tumor Hospital of Xinjiang Medical University between January 1, 2014, and May 31, 2023. We analyzed the effects of single and multiple pollutants on mortality risk using both univariate and multivariate Cox proportional hazard models. Meanwhile, we employed the Cox model to investigate the interaction between pairs of air pollutants. Then, an accelerated failure time (AFT) model was used to quantify the effects of air pollutants on the survival time of breast cancer patients, quantifying whether they accelerate or delay survival.

Results: The multivariate Cox model revealed that the highest quartile (Q₄) of SO₂ (HR=11.96, 95% CI: 4.68-30.55), CO (HR=4.58, 95% CI: 2.82-7.44), NO₂ (HR=3.83, 95% CI: 2.50-5.86), PM_2.5 (HR=2.67, 95% CI: 1.88-3.80), and PM₁₀ (HR=2.67, 95% CI: 1.88-3.80) significantly increased the risk of breast cancer mortality. In contrast, O₃ showed a dose-dependent protective effect (HR=0.19, 95% CI: 0.08-0.21). NO₂ significantly increased risk of death in breast cancer patients after introduction of particulate matter. The accelerated failure time model further revealed that SO₂ (Q₄-TR=0.18, 95% CI: 0.08-0.41) and CO (Q₄-TR=0.20, 95% CI: 0.12-0.33) reduced survival time to 18%-20% of the reference group (Q₁). O₃ demonstrated a dose-dependent reduction in mortality risk (Q₄-TR=7.29, 95% CI: 4.51-11.78); Notably, NO₂ and particulate matter (PM_2.5, PM₁₀) had a bidirectional effect-low concentrations (Q₂-Q₃) extended survival time (TR: 1.47-2.64), while high concentrations (Q₄) accelerated death (TR: 0.26-0.39).

Conclusion: Air pollution collectively impacts breast cancer mortality, with complex pollutant interactions modulating risk. This highlights the need for holistic environmental health strategies.

Purpose: This study aimed to evaluate the performance of the first-trimester Fetal Medicine Foundation (FMF) algorithm in predicting monosomy X and compare it with a Thai NT-based model using nuchal translucency (NT) alone or combined with maternal serum markers.

Patients and methods: This retrospective study analyzed 6,860 singleton pregnancies screened at 11-13+6 weeks. Monosomy X risk was estimated based on the trisomy 21 risk calculated by the FMF algorithm and Thai logistic regression models based on NT alone, NT with pregnancy-associated plasma protein A (PAPP-A), and NT with PAPP-A and beta-human chorionic gonadotropin (β-hCG).

Results: Thirty cases of monosomy X were identified (0.4%), all of which were confirmed prenatally by invasive diagnostic procedures, including amniocentesis, chorionic villus sampling, or cordocentesis. The Thai model using NT and PAPP-A had the highest area under the receiver operating characteristic curve (AUC) of 0.953, with a sensitivity of 86.7% and a specificity of 94.1%. NT alone also showed strong performance (sensitivity 83.3%, specificity 94.4%). The FMF algorithm achieved the highest specificity (97.9%) but lower sensitivity (53.3%). Adding β-hCG did not improve performance.

Conclusion: NT alone or combined with PAPP-A outperformed the FMF algorithm for monosomy X screening, with NT alone being particularly useful in settings without biochemical testing. The FMF algorithm, while primarily designed for trisomy 21 risk estimation, can also provide monosomy X risk within the same report at no additional cost, which is especially valuable in resource-limited settings where biochemical testing or NIPT is not widely accessible.